Kidney disease is a condition in which the kidneys no longer function as they should, causing extra fluid and waste to build up in the body. When these problems persist over a long period of time, chronic kidney disease (CKD) is diagnosed. If left untreated, CKD can progress to renal failure (kidney failure), which requires specialized treatments. There are currently several treatments available for CKD and renal failure, and more are being studied in clinical trials.
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Treatments for Early-Stage Kidney Disease
The treatments for early-stage CKD typically focus on treating the underlying health conditions that lead to CKD. People with high blood pressure, heart disease, and diabetes are all at a higher risk of developing CKD. This is because higher blood pressure and blood sugar levels damage the delicate blood vessels in the kidneys, making it harder for them to properly filter out waste and extra water.1
Medications for High Blood Pressure
Lowering your blood pressure can help protect your kidneys against further damage. There are a wide variety of medications that can be used, depending on your health. Some medications may put more strain on your kidneys, so your doctor will discuss which options are best for you.
Renin-Angiotensin System (RAS) Inhibitors to Treat Hypertension
RAS inhibitors include medication classes called ARBs (angiotensin II receptor blockers) and ACE inhibitors, both of which have been shown to reduce the risk of renal failure and end-stage renal disease (ESRD) in people with CKD.
Your body makes angiotensin II, a hormone that narrows your blood vessels and raises blood pressure. ARBs block the hormone from binding to its receptor, and ACE inhibitors block the angiotensin-converting enzyme that helps make angiotensin II. Both of these medications help lower your blood pressure by blocking angiotensin II, allowing your blood vessels to relax.2
Examples of ARBs include:3
- Losartan (Cozaar®)
- Valsartan (Diovan®)
- Telmisartan (Micardis®)
- Irbesartan (Avapro®)
Side effects of ARBs may include dizziness or lightheadedness, buildup of fluid that leads to swelling (angioedema), and elevated potassium levels (hyperkalemia).
Examples of ACE inhibitors include:4
- Lisinopril (Prinivil®, Zestril®)
- Captopril
- Quinapril (Accupril®)
- Enalapril (Vasotec®)
Side effects of ACE inhibitors may include fatigue or tiredness, headaches, dizziness or lightheadedness, elevated potassium levels (hyperkalemia), taste changes, or dry cough.
Diuretics for High Blood Pressure
Diuretics, or water pills, help remove extra fluid and salts from your body. Some diuretics also stimulate your kidneys to release more sodium into your urine, which pulls water out of your blood. This helps reduce the amount of fluid in your cardiovascular system, lowering your blood pressure.
There are three types of diuretics used to treat high blood pressure in people with CKD:5
- Loop — Furosemide (Lasix®), bumetanide (Bumex®), torsemide (Soaanz®)
- Thiazide — Chlorothalidone, hydrochlorothiazide
- Potassium-sparing — Amiloride (Midamor®), spironolactone (Aldactone®)
Potential side effects of diuretics include dizziness, dehydration, muscle cramps, headaches, or joint problems.
Beta-Blockers to Treat High Blood Pressure
Beta-blockers work by blocking epinephrine’s (adrenaline’s) effects in your cardiovascular system. This lowers your heart rate and dilates (widens) your blood vessels, both of which help lower your blood pressure. Beta-blockers are typically only used when other blood pressure medications haven’t worked. They can also be combined with other medications if needed.
Examples of beta-blockers include:6,7
- Atenolol (Tenormin®)
- Metoprolol (Toprol XL®, Lopressor®)
- Carvedilol (Coreg®, Coreg CR®)
Side effects of beta-blockers can include feeling dizzy or lightheaded, headaches, feeling tired or drowsy, runny nose, or changes in vision.
Carvedilol can also cause high blood sugar levels (hyperglycemia). If you begin to notice the signs of hyperglycemia, seek medical attention immediately. These include extreme thirst and hunger, blurred vision, and frequent urination.
Medications for Heart Disease
In addition to ACE inhibitors, beta-blockers, and diuretics, potassium binders can also be used to manage heart disease and CKD. These medications help remove extra potassium from your blood, which can build up in those with CKD. Hyperkalemia can also cause heart and muscle problems, so it’s important to keep your potassium levels within a healthy range.1
Examples of potassium binders include:8
- Sodium polystyrene sulfonate (SPS)
- Sodium zirconium cyclosilicate (SZC)
- Patiromer
Medications for Diabetes
If you have diabetes, keeping your blood sugar levels under control can also help you manage CKD. Diabetes can be broken down into type 1 diabetes (T1D) and type 2 diabetes (T2D).1
T1D is treated with insulin therapy, and keeping your blood sugar levels within a healthy range can help prevent CKD from developing and/or progressing. T2D can be managed using medications that help your pancreas make more insulin or sensitize your body’s cells to insulin. If needed, you can also use insulin therapy to help lower your average blood sugar levels (HbA1c).9
Some of these medications are associated with low blood sugar levels (hypoglycemia), which can become dangerous if left untreated. Symptoms of hypoglycemia include:10
- Dizziness
- Extreme hunger
- Rapid heartbeat
- Sweating
- Shaking
- Confusion or irritability
Treatments for Late-Stage Kidney Disease
Once CKD has progressed and your kidneys can no longer function on their own, you’ll need special treatments to filter your blood to remove waste and extra fluid. People with ESRD and renal failure require either dialysis or a kidney transplant in order to stay alive. Your doctor will discuss your options with you to choose the best for your case and overall health and well-being.
Dialysis
Dialysis is recommended when your kidneys are only functioning at 10 to 15 percent of their normal capacity. Dialysis not only filters your blood, but it also helps balance your blood pressure and levels of electrolytes in your body. There are two main types of dialysis — hemodialysis and peritoneal dialysis.11
Hemodialysis uses an artificial kidney (hemodialyzer) to filter your blood. Your doctor will make an access to the blood vessels in your arm or leg to allow blood to flow into the hemodialyzer. In some cases, they may use a thin, flexible plastic tube (catheter) that is inserted into a large vein in your neck for access. Hemodialysis treatments are typically done three times a week for around four hours each.
For peritoneal dialysis, your doctor inserts a catheter into your abdomen with surgery to make an access. During dialysis treatment, your peritoneal cavity (abdominal area) is filled with a fluid known as dialysate through the catheter. This fluid pulls out waste and extra water from the blood vessels in your peritoneal cavity, filtering your blood.
Some people on dialysis may experience a drop in blood pressure, which can cause headaches, nausea, and vomiting.
Kidney Transplant
Another treatment option for ESRD and renal failure is a kidney transplant. This is a surgery in which a damaged kidney is removed and replaced with a healthy kidney from a donor.12 Successful kidney transplants typically allow people with renal failure to live longer and with more freedom than those on dialysis. Research also shows that people who have kidney transplants live longer than those who stay on dialysis.
After a transplant, you’ll take medications that prevent your immune system from rejecting the new kidney. These medications can increase your risk of developing infections or certain types of cancer.
Is Kidney Disease Curable?
You may be wondering, “Can kidney disease be reversed?” Unfortunately, it can’t be completely reversed or cured. While a transplant may seem like a cure, there is a risk that your body will reject the new kidney. Transplants typically last several years, but this can vary from person to person. Younger people who get kidney transplants will likely need another later in life. It’s also important to continue to manage your health, blood pressure, and blood sugar levels in order to prevent further damage.12
Fortunately, the current treatments available to those with CKD, ESRD, and kidney failure can help you live a longer, healthier life. As research provides more information on CKD and renal failure, doctors and researchers continue to come up with new treatments. Many of these are currently in clinical trials to ensure they’re safe and effective.
